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The Surgeon as the Second Victim? Results of the Boston Intraoperative Adverse Events Surgeons’ Attitude (BISA) Study
*Kelsey Han, *Jordan Bohnen, *Thomas Peponis, *Myriam Martinez, *Anirudh Nandan, *Daniel D Yeh, *Jarone Lee, *Marc Demoya, *David King, George Velmahos, Haytham Kaafarani
Massachusetts General Hospital, Boston, MA

Objective: An intraoperative adverse event (iAE) is often directly attributable to the surgeon’s technical error and/or suboptimal intraoperative judgment. We aimed to examine the psychological impact of iAEs on surgeons as well as surgeons’ attitude regarding iAE reporting.
Design: Cross-sectional survey
Setting/Main Outcome Measures: We conducted a web-based survey of all surgeons at three major teaching hospitals of the same university. The 29-item questionnaire was developed using a systematic closed and open approach focused on assessing the surgeons’ 1) personal account of iAE incidence, 2) emotional response to iAEs, 3) available support systems and 4) perspective regarding the barriers to iAE reporting.
Results: The response rate was 44.8% (n=126). The mean respondents’ age was 49 years, 77% were male, and 83% performed >150 procedures/year. Over the last year, 32% recalled 1 iAE, 39% 2-5 iAEs, and 9% >6 iAEs. The emotional toll of iAEs was significant, with 84% of respondents reporting a combination of anxiety (66%), guilt (60%), sadness (52%), shame/embarrassment (42%) and anger (29%). Colleagues constituted the most helpful support system (42%), rather than friends or family; a few surgeons needed psychological therapy/counseling. Regarding reporting, 26% preferred not to see their individual iAE rates, while 38% wanted it reported in comparison to their aggregate colleagues’ rate. The most common barriers to reporting iAEs were fear of litigation (50%), lack of a standardized reporting system (49%), and the absence of a clear iAE definition (48%).
Conclusion: iAEs occur often, have a significant negative impact on surgeons’ wellbeing, and barriers to transparency are fear of litigation and absence of a well-defined reporting system. Efforts should be made to support surgeons and standardize reporting when iAEs occur.


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